[13C]urea breath test to confirm eradication of Helicobacter pylori

Abstract

Objective: To determine the utility of the [13C]urea breath test in confirming the eradication of Helicobacter pylori.

Methods: We reviewed our H. pylori database for patients who underwent [13C]urea breath test at baseline and 6 wk after triple therapy with tetracycline, metronidazole, and bismuth subsalicylate. Baseline infection was defined by the identification of the organism on antral biopsies or a reactive CLO test. Eradication was defined as a negative Warthin-Starry stain and a non-reactive CLO test at 24 h. All patients had a positive baseline [13C]urea breath test defined as [13C] enrichment > 6% at 60 min.

Results: One hundred eighteen H. pylori-infected patients (mean age 58.3 +/- 13.9 yr) met the review criteria (61 duodenal ulcers, 24 gastric ulcers, 33 non-ulcer dyspepsia). In 101/118 patients (86%), H. pylori was successfully eradicated (mean baseline breath test value 25.8 +/- 1.6). Of 101 patients, 95 had a negative 6-wk follow-up breath test (mean 2.2 +/- 0.2, p < 0.001). Of the 6/101 patients in whom treatment was successful, and who remained breath test positive at 6 wk, 4/6 were breath test negative when retested at 3 months. The remaining two patients were lost to follow-up. In 17/118 (14%) patients, H. pylori failed to be eradicated (mean baseline breath test 22.4 +/- 3.6). Fifteen of 17 patients had a positive breath test at 6 wk (mean 19.9 +/- 3.7). Two of 17 with a negative breath test at 6 wk tested positive when the breath test was repeated at 3 months. The sensitivity and specificity of [13C]urea breath test at 6 wk posttreatment are 97% and 71%, respectively. The positive and negative predictive values are 94% and 88%, respectively.

Conclusions: [13C]urea breath test is a sensitive indicator of H. pylori eradication 6 wk after treatment. Antral biopsies are unnecessary to confirm eradication of H. pylori after completion of treatment.